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Postnatal depression - your questions answered

Dr Mark Winwood, our psychological health expert, recently hosted a live chat and answered your questions regarding postnatal depression -- its symptoms, how to identify it and how to make sure you get the right kind of help.

Here is a summary of that session:

What are the main reasons for women developing postnatal depression?

This isn’t an easy one to answer - there is no single known cause for postnatal depression, and sometimes it can start for no obvious reason. However, some researchers have suggested a number of possibilities.

Some think it is likely to be biological; for example, changes in the body, including hormonal changes. However, although some studies show that changes in the level of hormones during pregnancy and after birth can trigger changes in mood, only some women go on to develop postnatal depression – so hormones are unlikely to be the single cause.

Others think the cause is linked to past experiences or social circumstances. Many suggest that a combination of different issues cause postnatal depression.

Some situations are considered to put someone at particular risk of developing postnatal depression:

  • previous mental health problems
  • lack of support
  • experience of abuse
  • low self-esteem
  • poverty and poor living conditions
  • major life events.

How long can postnatal depression last for? Is it as severe as normal depression - I know someone who suffers from depression and has done for about 20 years.

Postnatal depression can start some time after giving birth. It is also not usual for someone to have the symptoms for a couple of years. They can then return if left untreated. Other factors can also trigger depression, and like many other forms of depression the symptoms may recur after successful treatment, and there are many contributory factors.

Hormonal factors certainly play an important role, and any kind of worries or anxieties and any lifestyle changes such as moving house or changing jobs can also influence mood.

Symptoms start ordinarily four to six weeks after the birth of the child. Depending on the severity of the symptoms and the sort of treatment applied the time to resolution will be different. It may last several months and sometimes up to a year depending on treatment resistance. For some untreated symptoms it can last much longer - so it is important to get the correct support and help.

And 'yes' postnatal depression can be and is as severe as any other depressive disorder and should be treated as such.

How common is postnatal depression?

If you looked at five different resources you would get five different answers. It is all down to reporting and diagnosis. It is felt that postnatal depression is often misdiagnosed or under-diagnosed. I would say that the 'baby-blues' is very common and exists for about 85% of new mothers in the UK. The more severe depressive disorder that is formally assessed would be in the region of 10 - 15% of new mothers in the UK.

What advice would you give to a mother who is struggling but feels guilty for the way she feels? It's not an easy subject to bring up at a time when you are expected to be feeling very joyful.

I think every mum in the world would empathise with your statement. I think the first thing I can suggest is to talk to a friend or close family member who has also had a child (recently if possible) - someone you feel comfortable in confiding in. It's an old saying but 'a problem shared......'(you know the rest!). You will find you are not alone in your feelings. If you look at the website 'mumsnet' they describe some research that suggests that the more peer support you can get the better.

A few more tips:

  • Find people who can help you with child care, housework, and errands so you can get some much needed rest.
  • Make time for yourself every day, even if it’s only for 15 minutes.
  • Do something relaxing or that makes you feel good about yourself.
  • Keep a daily diary of your emotions and thoughts. This is a good way to let everything out and to keep track of your progress as you begin to feel better.
  • Give yourself credit for the things you’re able to accomplish, even if you only get one thing done in a day.
  • If you aren’t able to get anything done, don’t be hard on yourself.
  • Give yourself permission to feel overwhelmed.
  • Remember that no one expects you to be supermum.
  • Be honest about how much you can do and ask others for help.

Here are a few helpful web-sites for you:

  • www.mumsnet.com
  • www.pnddepressionsupport.co.uk
  • www.PNI.org.uk

How can I help those with postnatal depression?

I will give you some basic ideas. Please remember there is no 'one size fits all' but some of these might help.

  • Please make sure that the Mum who is suffering sees a sympathetic doctor about her postnatal depression. If necessary go with her and ensure she tells the doctor the full problem.
  • Please remember that this is an illness, as much as any other illness. She cannot help it, or "pull herself together" however much she tries or may want to.
  • Listen to her as much as you can. Ask her about her thoughts and feelings. Give her time.
  • You can't offer a solution or a "fix" for her depression but just listening and maybe hugging and reassuring her is hugely important.
  • Try and be sympathetic even if it is boring to listen to the same thoughts and emotions over and over again.
  • There will be good days and bad days. Help as much as you can with practical stuff but also let her do as much as she wants to. Leave her role in the home as open for her as possible so she doesn't feel she is a failure and you are taking over. Talk things over together so you both have a clear idea of what is helpful and what is not helpful!
  • Don't push her to do things or go places that she feels uncomfortable with.
  • Let her lead the way and set the pace.
  • She may hate being left alone, especially in the early days. If so try and rally family and friends so there is always someone with her that she is comfortable with.
  • Help with childcare and suggest she spends the time doing something just for her.
  • Reassure and remind her - and yourself - that the support she gets will help her recover.

Is it common for men to suffer from postnatal depression and is there a lot of help out there for father's who do suffer?

Interesting question - some research was done in 2010 which demonstrated that up to 21% of men in their sample had some depressive symptoms in the first year of their of child's life.

If the mum is suffering from postnatal depression, it can then impact on the father causing them to also have a depressive episode. When there is a lot of pressure financially, emotionally and physically on the man this can cause excessive stress which can then lead to depression. Dads are at a higher risk if they have previously suffered from depression earlier in life.

A considerable factor can be that the balance and focus has shifted in the relationship, all the attention in now taken up on the baby, resulting in not much time as a couple. Also if it is a single Dad, having the full responsibility of caring for a new born baby with no support from a partner or the Mum.

Evidence suggests that fathers can be impacted by postnatal depression in their partners, same sex partners will be impacted in a similar way although there is less research in this area. The other individuals who will experience the effects of mum's depressive symptoms are the other children in the family. There is evidence to suggest that a child's psychological state will effected by their parents depression and can affect the general wellbeing of the child.

Clearly - if someone is depressed the symptoms they have can affect everyone in the system (family, work, friendship networks) so any support and treatment offered should take this into consideration.

Do you think pressure to breastfeed is a significant catalyst for postnatal depression? Are we setting some mums up for depression and guilt by stigmatizing the alternative so heavily?

I think any pressure a woman is given which can be interpreted as them not being a good mother or not doing the best for their child could be a catalyst for that mother to feel depressed or more depressed if they already have postnatal depression. This is a quote from 2007 'current breastfeeding promotion strategies are communicated may contribute to feelings of guilt and fears of inadequacy by mothers suffering from depression'. So I believe this could be a factor in the development of someone's negative self-belief and lead to depressive symptoms

A few more facts - breast feeding is not a physiological factor in the development of postnatal depression. Studies have found that breastfeeding can ease postnatal depression as it reassures mothers of their ability to nurture and bond with their babies. There is also the production of Oxytocin that occurs when you breastfeed - which is naturally produced 'feel good' substance.

If you have postnatal depression after one birth will it happen again after the next birth?

This is a question that asks us to think about risk factors in the development of postnatal depression. If you have experienced a mental health problem in the past – including during pregnancy – this may recur after you have given birth. It is also important to be aware that what caused your mental health problem in the past, can also put you at risk of postnatal depression.

If you experienced postnatal depression after the birth of one child, you are at increased risk of developing postnatal depression after the birth of your next child. However, you may have coped well with you first child, and felt depressed after the second, or the other way around.

If I suffer depression normally will I have more chance of postnatal?

One of the risk factors of developing postnatal depression is a previous history of depression. This does not mean you will automatically suffer from postnatal depression but it is important to discuss this with your GP/health visitor or midwife so the correct assessments and supports can be put in place for you.

Does postnatal depression run in families?

This is a 'hot off the press' topic at the moment. Researchers in the Midlands (I think Coventry) have identified a variant of a gene that can contribute to the incidence of postnatal depression. This gene is found in the brain. So this would indicate there may well be a genetic link - but the research is very new.

However, we have been aware for years that mental health problems can run in families, so to speak, and there has been evidence to suggest that there is a familial link to depressive illness. We are not convinced whether this is a biological link (although the recent research suggests it may be) or a link due to social factors.

If you have a history of POSTNATAL DEPRESSION in your family it is important to tell your healthcare team so they can correctly support you.

Will my baby be affected if I get depression during pregnancy or after the birth?

While pregnant if you are experiencing depression the main effects on the baby will be due to any medication you are taking to ease your symptoms or any behaviours you are engaging in/or not engaging due to your psychological problem. What I mean by this is if you are not taking care of yourself or using drugs or alcohol.

Again immediately after birth, medication may have an impact on baby and there is some evidence to suggest that early bonding and some cognitive developmental problems may occur.

For these reasons it is really important to get professional advice and support if you experience mood problems and also to check any medication you are taking with your GP.

Can anti-depressants be dangerous for breastfed babies?

Your GP can prescribe medication to help with postnatal depression. But it's important to discuss potential benefits and side effects fully, before taking any, and to keep monitoring progress with them. Medication may enter breast milk, and if you/the mother is breast feeding you will need to bear this in mind when deciding whether or not to take it. Some drugs have known effects on infants, while others appear to be quite safe, so it is important to discuss this with your doctor. If you do decide to try medication, it may be necessary to try different drugs to achieve the best results and your doctor will advise you on drugs that are safe for you and your baby as certain medications are not indicated for pregnant mums or those breastfeeding.

All antidepressants take time to work. If you do take them, they can be very effective, but you should be prepared to take them for at least six months. They also all have possible side effects, and when you stop taking them you should withdraw slowly, to avoid possible withdrawal effects which can be unpleasant.

Is there any way to prevent postnatal depression or treat it before it becomes a real problem?

This is a really important question. The NHS is guided by the principals recommended by NICE (National Institute for Clinical Excellence in Health) - this body recommends that all pregnant woman are screened for their 'risk' of developing postnatal depression (and other psychological problems) and if they fall into a high-risk category then preventative treatment should be offered to try and reduce the risk of symptoms developing post-partum. As part of this guidance all women should also be assessed following birth and at health visitor sessions for any changes to mood so that any symptoms that do occur can be managed more quickly.

So if the necessary screening and assessments are carried out it is possible to effect the possibility of symptoms occurring. However, this is not 100% successful and unforeseen things can happen during the birthing process or after the birth that may affect an individual's mood and ability to cope that could not have been predicted.

What is puerperal psychosis?

Puerperal Psychosis - also known as Post-Partum Psychosis (PPP) is a much less common condition than postnatal depression. Where we feel that around 15 in 100 woman may have postnatal depression only 1 in 1000 women experience PPP.

It is a severe episode of mental illness which begins suddenly in the days or weeks after having a baby. Symptoms vary and can change rapidly. They can include high mood (mania), depression, confusion, hallucinations and delusions. Puerperal psychosis is a psychiatric emergency. Professional help needs to be accessed immediately.

This can happen to any woman. It often occurs ‘out of the blue’ to women who have not been ill before. It can be a frightening experience for women, their partners, friends and family. Women usually recover fully after an episode.


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